However, it remains unclear which individual species and strains of probiotics are the most beneficial.

More evidence is also required before the role in IBS is known of prebiotics (which promote growth of probiotics) or synbiotics (which combine probiotics and prebiotics). The effectiveness of all three therapies in chronic idiopathic/functional constipation (CIC) is also lacking and uncertain.

Source: Ford AC, et al. Am J Gastroenterol. October 2014.

Scientists Create Model Human Stomachs to Study Gastric Diseases

November 10, 2014 – Using stem cells from adult donors, scientists have been able to grow pea-sized three-dimensional human stomach models under laboratory conditions. These miniature stomachs were developed to model mechanisms of infection by the bacterium Helicobacter pylori, which can cause gastric symptoms including nausea, bloating, and vomiting and can lead to ulcers and stomach cancer in extreme cases.

These models are expected to provide a valuable experimental model for the study of the development, functioning, and diseases of the human stomach.

Source: McCracken KW, et al. Nature. October 2014.

Key Symptoms in Functional Dyspepsia

November 6, 2014 – Researchers of a focus group study confirmed that symptoms corresponding to fullness after meals (postprandial) and early fullness (satiation) are the key symptoms for developing a patient reported outcomes (PRO) instrument for meal-related functional dyspepsia (FD)/postprandial distress syndrome (PDS). This information is useful for creating tools used to measure treatment effectiveness.

Under a program called PROMIS (Patient Reported Outcomes Measurement Information System), funded by the National Institutes of Health (NIH), PRO tools for various conditions are being developed which will help design treatment plans for individuals, improve doctor-patient communication, and manage chronic conditions.

Source: Carbone F, et al. Neurogastroenterol Motil. September 2014.

Yoga for Young People with IBS

October 30, 2014 – Researchers concluded that therapy for irritable bowel syndrome (IBS) using Iyengar yoga training – 1.5 hour sessions twice weekly for six weeks – is a safe and beneficial compliment to medical care in young people, particularly young adults.

The randomized controlled study involved an initial total of 51 participants including adolescents (ages 14–17) and young adults (ages 18–26) with IBS or recurrent abdominal pain. Physical functioning improved in adolescents, and IBS symptoms, emotional distress, fatigue, and sleep quality improved in young adults.

Iyengar yoga postures are taught in a sequence to address specific problems by teachers who receive training in anatomy, physiology, and safety.

Source: Evans S, et al. J Pediatr Gastroenterol Nutr. August 2014.

Preliminary News on Treatments Reported at the 2014 ACG Meeting

October 23, 2014 – Here are some brief reports on research studies that were presented as abstracts at the 2014 annual American College of Gastroenterology (ACG) Scientific Meeting, a conference for medical professionals.

The data and conclusions from these findings should be considered preliminary until published in a peer-reviewed journal.

Chronic Idiopathic/Functional Constipation (CIC)

Two-thirds of patients with CIC treated with lubiprostone (Amitiza) in three pivotal phase 3 studies in the US and Japan responded to the treatment after 2 weeks of therapy.

Dyspepsia and Chronic Idiopathic Constipation (CIC) with Bloating

Symptoms of functional dyspepsia (1 or more of feelings of fullness after a meal, early feeling of fullness, upper GI (epigastric) pain, or upper GI burning) are often reported by people with CIC with abdominal bloating. A study of CIC patients with abdominal bloating found that linaclotide (Linzess) provided significant relief for functional dyspepsia symptoms compared to placebo.

Gastroparesis

The majority of 138 patients with diabetic and idiopathic gastroparesis resistant to medical therapy (medically refractory) who were surveyed at least 6 months after being treated surgically with insertion of a gastric electric stimulator (GES) reported improvement of symptoms, especially loss of appetite, nausea, and retching (dry heaves).

Another study of 12 patients with medically refractory gastroparesis found improvement in nausea, vomiting, and nutritional parameters 5 years after GES therapy.

An evaluation of 31 patients with medically refractory gastroparesis found that after 1 year of GES those who also continued on prokinetic medications had improved symptom scores, greater weight gain, and decreased use of tube feeding (enteral nutrition) compared to those who discontinued prokinetic medications.

IBS in Children

A study involving 97 children and adolescents recently diagnosed with IBS found that two 90-minute sessions of multi-disciplinary behavioral therapy interventions significantly reduced healthcare utilization up to 4 years after diagnosis. The therapy included patient and parental education, dietary modification, exercise, relaxation techniques, and guided imagery.

IBS with Constipation (IBS-C)

Patients with IBS-C treated with linaclotide (Linzess) for up to 2 years were satisfied with treatment on average. The most frequent side-effect, diarrhea, was generally mild or moderate and easily managed.

Data from a phase 2 dose-ranging study of 424 adults to assess the safety and efficacy of plecanatide (a GC-C agonist) in patients with IBS-C concluded that the investigational therapy was well-tolerated and improved bowel habit and abdominal pain symptoms over a 12-week treatment period. (This agent is also in phase 3 trials for the treatment of chronic idiopathic constipation).

IBS with Diarrhea (IBS-D)

The investigational drug, eluxadoline, significantly improved IBS-D symptoms compared to placebo in patients enrolled in a study, including in those who had used loperamide without improvement in the prior year.

Another study found eluxadoline to significantly improve urgency, concluding this to be a valuable measure of response compared to placebo.

Based on results of a survey of IBS patients, researchers suggest that clinicians pay special attention in treatment plans to areas which affect quality of life, such as food avoidance, as well as to those that have effects on daily activities and relationships, especially in individuals with IBS-D.

IBS-D, IBS-C, and Mixed IBS (IBS-M)

A case series study over an 8-week period looked at treatment of 18 difficult to treat patients (14 with IBS, 2 with Crohn's disease, 2 with other bowel conditions) using the prescription oral medical food serum-derived bovine immunoglobulin/protein isolate (SBI) in addition to standards of care. Overall symptom improvement was seen in stool consistency, decreased stool frequency, abdominal pain, bloating, distension, and incontinence. The study concluded that dietary management with SBI can provide a safe and effective therapy for patients with IBS and other GI conditions.

Self-Help for IBS

Participants with IBS who completed a randomized, controlled, study of 6-week cognitive behavioral therapy using a self-help workbook experienced significant improvement in health related quality of life and symptom severity. Self-help workbooks designed to help manage psychological aspects of IBS can be added to medical management and may improve treatment outcomes.

Another study using a 9-week comprehensive self-management program designed for the treatment of IBS found that after 1 year the majority of participants still used some strategies from the program based on what was most effective for them. Strategies included meal timing/frequency, trigger food reduction, eating behaviors (like avoiding eating out and eating more slowly), eating a balanced diet, specific relaxation strategies, lifestyle behaviors (like exercise and hobbies), addressing thought distortions, challenging beliefs (like perfectionism and self-esteem), and problem-solving skills.

Structure and Functions of the Gut Microbiome

October 21, 2014 – In a published article, researchers describe how the understanding of human gut microbiology has undergone a leap forward over the past decade. The composition and function of the microbiome (the microbial gut community, especially bacteria), although stable over long periods, may be influenced by a number of factors including genetics, mode of birth delivery, age, diet, geographic location, and medical treatments.

Changes in the microbiome structure have been linked to inflammatory, functional, and metabolic disorders such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and obesity. It remains to be known whether these changes are a contributing factor or a result of the disease.

Integrated Treatments in IBS

October 16, 2014 – In a review of IBS treatment studies, investigators summarized the most widely used complementary and alternative medicine (CAM) approaches that have proven effectiveness and have been endorsed by professional organizations. Examples include specific modalities of hypnotherapy, cognitive behavioral therapy, acupuncture, and yoga.

The reviewers encourage the use of both conventional medicine and CAM approaches by doctors in an integrative setting to provide the best outcome and quality of life to affected individuals.

Source: Grundmann O, Saunjoo LY. World J Gastroenterol. January 2014.

Nortriptyline Lacks Effectiveness in Idiopathic Gastroparesis

October 16, 2014 – Researchers in a randomized controlled clinical trial concluded that, among patients with idiopathic gastroparesis, the use of the antidepressant nortriptyline compared with placebo for 15 weeks did not result in improvement in overall symptoms. These findings do not support the use of nortriptyline for idiopathic gastroparesis.

Gastroparesis remains a challenging syndrome to manage, with few effective treatments and a lack of rigorously controlled trials. Tricyclic antidepressants are often used to treat refractory symptoms of nausea, vomiting, and abdominal pain despite a lack of evidence from well-designed studies for this use.

October 10, 2014 – Researchers in a large study concluded that monitoring individuals with Barrett's esophagus in an endoscopic surveillance program to watch for signs of abnormal tissue (dysplasia) or cancer was associated with lower tumor stages and reduced esophageal cancer-related mortality than those with Barrett's esophagus who did not participate in surveillance.

The study included 10,000 individuals diagnosed in the Netherlands with cancer of the esophagus. Nearly 800 (8%) of these had been diagnosed with Barrett's esophagus prior to the cancer diagnosis. Barrett's esophagus is one of several factors associated with increased risk of developing esophageal cancer. As with all cancers, early detection is critical to improving treatment outcomes. Learn more about Barrett's esophagus here

Source: Verbeek RE, et al. Am J Gastroenterol. August 2014.

Dietary Elimination Therapy for Eosinophilic Esophagitis

October 6, 2014 – A review of existing data of 31 individuals demonstrated that dietary elimination therapy is a safe and effective treatment in adults with eosinophilic esophagitis (EoE). Individuals underwent either a targeted elimination diet that isolated specific food allergies or a more general 6–food elimination diet. Individuals with EoE most frequently reacted to dairy (44%), eggs (44%), wheat (22%), shellfish (11%), legumes (11%), and nuts (11%).

While both diets were difficult for individuals to stick to, the targeted diet had greater success rates. Oral steroids and diet modification are the only therapies currently available for individuals with EoE.

Source: Wolf WA, et al. Clin Gastroenterol Hepatol. August 2014.

Biomarkers May Help Predict Risk for Barrett's Esophagus

September 22, 2014 – A study of 141 mostly white male veterans concluded that a prediction model based on a risk score of circulating levels of several specific substances in the blood (serum biomarkers) in addition to individual demographic and clinical information (age, sex, race, and waist-to-hip ratio as well as gastroesophageal reflux [GER] frequency and duration and H. pylori status) may help identify persons at risk for Barrett's esophagus more accurately than not including the multi-biomarker risk score.

More research is needed to validate these results in the general population and to see if there are additional biomarkers that can be included to improve the predictive value of this model even further.

Source: Thrift AP, et al. Clin Gastroenterol Hepatol. August 2014.

FDA Considers Rifaximin for Treatment of IBS-D

September 19, 2014 – The supplemental new drug application (sNDA) for rifaximin 550 mg has been accepted for review by the U.S. Food & Drug Administration (FDA). Rifaximin is an antibiotic under investigation for the treatment of irritable bowel syndrome with diarrhea (IBS-D). A decision from the FDA regarding the approval status of the drug is expected by Feb 28, 2015. Learn more

Symptom Episodes in IBS: Consequences for Treatment Procedure

September 18, 2014 – A study involving 185 individuals with irritable bowel syndrome (IBS) found that symptoms, including diarrhea, constipation, and abdominal pain, as well as bloating, tend to occur as episodes, over 2–4 days on average, rather than either sporadically or at regular intervals. Roughly half of individuals experienced a mixture of diarrhea and constipation episodes. Episodes of pain were not consistently relieved by a bowel movement or associated with a change in the frequency or consistency of stool.

Better understanding of the nature of episodic symptoms may help doctors and patients improve treatment regimens.

Source: Palsson OS, et al. Am J Gastroenterol. July 2014.

Statins May Reduce Risk of Barrett's Esophagus

September 9, 2014 – In a study of veterans, statin use was associated with a reduced risk of Barrett's esophagus. Statins are a class of drugs used to lower cholesterol.

This effect was most pronounced in obese individuals and those with a high waist to hip ratio (WHR). The study population included 303 individuals with Barrett's esophagus and 909 controls without Barrett's esophagus.

Source: Nguyen T, et al. Gastroenterology. August 2014.

6-Year Safety Report of the LINX System for GERD

September 9, 2014 – A safety analysis recently published for the LINX system magnetic sphincter augmentation device (MSAD) for gastroesophageal reflux disease (GERD) reported a low risk profile with no serious events leading to long-term complications associated with the device.

LINX is a surgically implanted device that works by reinforcing the lower esophageal sphincter (LES).

The first 1,000 individuals who underwent the procedure were reevaluated after 6 years. The analysis concluded that the safety profile for the procedure performed by an experienced surgeon establishes it as a viable option for individuals with uncomplicated GERD who are considering antireflux surgery

Source: Lipham JC, et al. Dis Esophagus. June 2014.

Gene Mutation Identified in IBS

September 5, 2014 – A survey of over 500 individuals confirmed a 2.2% prevalence of a mutation in a gene (SCN5A) in individuals with irritable bowel syndrome (IBS), as reported in an earlier pilot study. The SCN5A gene encodes a mechanism (sodium channels) involved in maintaining normal gastrointestinal (GI) motility.

The role of individual genes in symptom generation and expression in IBS remains largely unknown. Identification of these genes and their effects on the structure and function of the GI tract has the potential to reveal the mechanism of IBS in a subset of individuals with the disorder and shed light on new treatment pathways.

Source: Beyder A, et al. Gastroenterology. June 2014.

Different Anatomy in Individuals with GERD

September 5, 2014 – A study using magnetic resonance imaging (MRI) of 48 people found that those with mild to moderate gastroesophageal reflux disease (GERD) have several anatomical differences relating to the reflux barrier compared to healthy volunteers.

Primary among them, the angle of the esophagus (food tube) into the stomach was found to be wider in individuals with GERD compared with healthy individuals. This angle is an essential part of the way the body prevents reflux, called the "flap valve" mechanism. Also, the opening from the esophagus to the stomach (the esophagogastric junction), a key defense against the reflux of stomach contents after a large meal, was found to open wider in individuals with GERD. Differences in both of these structures in individuals with GERD are suspected to contribute to reflux.

Source: Curcic J, et al. Am J Gastroenterol. May 2014.

Newer Serotonin Drugs

August 13, 2014 – Researchers are finding new serotonin drugs that may help treat a variety of functional gastrointestinal (GI) disorders with improved safety.

A new generation of 5-HT4 receptor agonists is useful in treating symptoms of functional constipation, and have an improved safety profile compared to older drugs in this class.

A relatively new serotonin drug to treat irritable bowel syndrome with diarrhea (IBS-D) is also being developed. The drug, ramosetron (a 5HT3 receptor antagonist), has been associated with improved stool consistency in nearly 300 men with IBS-D in Japan. It appears to have an improved safety profile compared to other drugs in this class.

Source: Camilleri M. Neurogastroenterol Motil. August 2014.

GERD or Functional Dyspepsia?

August 13, 2014 – In a review of records, researchers at Mayo Clinic found an increase over a two decade period in gastroesophageal reflux disease (GERD) diagnosis rates, but no increase in reported GERD symptoms. About 6 out of 10 persons reporting GERD symptoms received a GERD diagnosis while only about 1 out of 10 persons reporting functional dyspepsia (FD) symptoms received an FD diagnosis.

Common symptoms of GERD – heartburn and/or acid regurgitation – are also reported in about one-third of people with FD. However, treatments differ for these 2 conditions and PPIs that treat GERD do not work for FD.

Source: Pleyer C, et al. Neurogastroenterol Motil. August 2014.

Microbiota Transplant for Treatment of C. difficile

August 12, 2014 – A study involving existing medical information collected on 75 adults and 5 children from 16 different medical centers concluded that fecal microbiota transplant (FMT) appears to be safe and effective for treating C. difficile infection in people who have weakened immune systems.

Up to 15–20% of cases of antibiotic-associated recurrent diarrhea and colitis presented in hospitals are attributed to C. difficile infection. FMT helps restore the balance of beneficial microorganisms lost to antibiotic use, and is indicated for people who have not been helped by standard therapies for C. difficile. However, the use of this treatment among individuals with weakened immune systems has been limited due to concerns about safety.

Source: Kelly CR, et al. Am J Gastroenterol. July 2014.

Acid Reflux Therapy

August 12, 2014 – Proton pump inhibitors (PPIs) reduce stomach acid production and are widely used to treat gastroesophageal reflux disease (GERD). However, in about 30% of patients PPIs do not adequately resolve symptoms.

Researchers looking at the occurrence of acid reflux events concluded that strategies which target the pool of acid (called the acid pocket) that floats on the top of ingested food after a meal may be effective for people with GERD who are not helped by PPIs alone.

Altering the size, position, and acidity of the acid pocket while using a PPI may add therapeutic benefit.

Source: Rohof WO, et al. Clin Gastroenterol Hepatol. July 2014.

Naloxegol Indicated for Opioid-Induced Constipation

August 11, 2014 – In two large phase 3 studies, the drug naloxegol was assessed for safety and efficacy in the treatment of opioid-induced constipation in individuals taking opioids for non-cancer related pain. At daily doses of both 12.5 mg and 25 mg the drug was associated with a significant reduction in constipation symptoms. Side effects were more frequent at higher doses and most often included gastrointestinal (GI) effects (abdominal pain, diarrhea, nausea, and vomiting).

Naloxegol is a member of an emerging class of drugs (peripherally acting µ-opioid receptor antagonists) that decrease the GI side effects of opioids without reducing their painkilling effects. Naloxegol is indicated for use by individuals suffering from opioid-induced constipation who have not responded satisfactorily to standard laxative therapy.

Source: Chey WD, et al. New Engl J Med. June 2014.

Authors Call for Standardization of the Decision to Refer for Anti-Reflux Procedures

August 11, 2014 – No current standards exist regarding decisions by medical professionals to refer children with severe gastroesophageal reflux disease (GERD) for anti-reflux procedures, including surgery. Decisions may be greatly influenced by parental and referring physician opinions. Standardization based on data showing the safety and effectiveness of treatments is recommended by the authors.

Source: Papic JC, et al. Surgery. May 2014.

IBS and IBD Similarities

August 8, 2014 – A review of existing studies of inflammatory bowel disease (IBD) and of irritable bowel syndrome (IBS) found a number of shared factors contributing to both disorders. In some instances these shared factors may involve brain-gut dysfunction, genetics, abnormal microbiota, low-grade inflammation in some IBS patients, and IBS symptoms in some patients with IBD in remission.

Source: Barbara G, et al. Curr Opin Gastroenterol. May 2014.

Probiotics in Constipation and IBS

August 8, 2014 – A review of existing randomized controlled studies aimed to summarize the usefulness of probiotics in health and disease. The researchers concluded that certain strains or combinations may be of benefit in managing constipation and in improving irritable bowel syndrome (IBS) symptoms, among other things. The summary is intended to provide a guide to healthcare providers working with patients.

Source: Taibi A, Comelli EM. Appl Physiol Nutr Metab. May 2014.

Targeting IBS Treatment

August 8, 2014 – Researchers reviewing existing studies found an imbalance of certain cells (cytokines) involved in regulating inflammation and sensitization in people with irritable bowel syndrome (IBS) compared to people without IBS. Using a cytokine profile may eventually be one way to help individualize treatment for people with IBS.

Foods that Worsen GI Symptoms

August 8, 2014 – A study of 25 children with functional gastrointestinal (GI) disorders revealed that specific foods are perceived by children to worsen their GI symptoms. These most often included spicy foods, cow’s milk, and pizza. Common coping strategies identified were consuming smaller portions, modifying foods, and avoiding problem foods.

Source: Carlson M, et al. J Acad Nutr Diet. March 2014.

New Guidance on Treatments for Sphincter of Oddi Dysfunction

August 8, 2014 – Results of a new study indicate that ERCP and surgery (sphincterotomy) are not reliably effective treatments of pain resulting from sphincter of Oddi dysfunction (SOD). Because these procedures carry substantial risk, the authors do not recommend the continued use of ERCP and sphincterotomy for abdominal pain following cholecystectomy – removal of the gallbladder.

SOD describes a condition in which the sphincter does not relax at the appropriate time, most often due to scarring or muscle spasm. The back-up of digestive juices that results can cause episodes of severe abdominal pain.

Source: Cotton PB, et al. JAMA. May 2014.

Home Parenteral Nutrition for Infants with Ultra-Short Bowel Syndrome

August 8, 2014 – Because of the long-term complications associated with intestinal transplantation, the authors in a new study for the treatment of infants with ultra-short bowel syndrome (U-SBS) recommend a non-transplant home parenteral nutrition approach (in the absence of liver disease).

Parenteral nutrition is an intravenous feeding technique that delivers nutrition directly into the blood stream.

Source: Diamanti A, et al. J Ped Gastroenterol Nutr. April 2014.

Restrictive Eating and Abnormal Gut Function

August 8, 2014 – Results from a preliminary study of adolescents with irritable bowel syndrome (IBS) suggest that frequent bouts of restrictive eating – such as not eating when hungry or eliminating certain foods – are associated with abnormalities in gastric sensation and gut motility. These gastrointestinal symptoms have been noted in association with other conditions characterized by restrictive eating. Results of this study warrant further investigation.

July 23, 2014 – The National Institute for Health and Care Excellence (NICE) has issued guidance on the use of lubiprostone (Amitiza) for treating chronic idiopathic constipation in the United Kingdom. The guidelines stipulate that the drug should only be considered in adults who have tried at least 2 laxatives at the highest tolerated recommended doses for at least 6 months, but who have not seen an improvement in their symptoms.

NICE clinical guidelines are recommendations on the appropriate treatment and care of people with specific diseases and conditions within the National Health Service (NHS) in the UK.

Results Positive in Study of Rifaximin Repeat Treatment for IBS-D

July 1, 2014 – Salix Pharmaceuticals reported positive results from the TARGET 3 – Phase 3 study to evaluate the efficacy and safety of repeat 14 day treatment with rifaximin for the treatment of irritable bowel syndrome with diarrhea (IBS-D) in people who responded to an initial 14 day treatment course with rifaximin. Compared to placebo, subjects treated with rifaximin showed statistically significant improvement in IBS-related abdominal pain and stool consistency during the 4 week treatment-free follow-up period in the double blind repeat treatment phase.

Study Underway to Evaluate new GERD Treatment

June 30, 2014 – A phase 2 study is underway on a new drug to treat gastroesophageal reflux disease (GERD) in patients not adequately helped by proton pump inhibitors (PPIs). The study will assess the effect of the drug (IW-3718) compared to placebo as an added treatment in GERD patients who will continue to also take a once-daily PPI. Ironwood Pharmaceuticals is developing the drug.

May 28, 2014 – Fructose can trigger or worsen symptoms in irritable bowel syndrome (IBS). A new study investigated the prevalence of symptomatic fructose malabsorption in those with IBS and tested whether any patient characteristics can help to detect fructose malabsorption.

After ingesting 25g of fructose, fructose malabsorption was found in 22% of those studied. Symptoms indicating intolerance to fructose were found in 28% of sampled individuals, not all of whom demonstrated malabsorption. There were no differences in IBS subtype or clinical symptoms between those who did or did not have malabsorption. However, young males had a greater incidence of malabsorption.

The authors recommend further studies to determine whether a low-fructose diet would help IBS patients who are intolerant to fructose, with and without malabsorption.

May 20, 2014 – A retrospective database study of existing records has found that people with diagnoses of severe chronic constipation (CC) have a potentially higher risk of developing colorectal cancer and non-cancerous (benign) colorectal tumors over time, compared to people without CC.

The study, which looked at medical record databases, reviewed data from over 100,000 patients (28,854 patients with CC and 86,562 without) for 2–5 years. In those with CC, 2.7% developed colorectal cancer vs. 1.7% of those without. For non-cancerous colorectal tumors, the proportion was 24.8% for those with CC and 11.9% for those without. The risks increased with the severity of the chronic constipation.

These findings demonstrate an association only – not a causation – between chronic constipation and the development of colorectal cancer and/or benign tumor. While further studies are needed to determine whether there is an underlying causal link, the authors recommend that doctors be aware of this potential association in order to monitor and treat their patients appropriately.

Bowel Disease A-To-Z Guide Launched In UK

May 09, 2014 – The Association of Coloproctology of Great Britain and Ireland has launched a guide on their website to help patients find expert surgeons. The guide classifies surgeons by location as well as by their interest a large variety of different bowel conditions.

UK residents who need surgery as part of their treatment can use the guide to find a surgeon who specializes in their condition.

DDW-2014 News

These studies were presented as abstracts at the 2014 Digestive Disease Week (DDW), a conference for medical professionals.

The data and conclusions from these findings should be considered preliminary until published in a peer-reviewed journal.

Novel Drug for Celiac Disease Reduces GI and Non-GI Symptoms

May 07, 2014 – A novel drug designed for the treatment of celiac disease reduced both gastrointestinal (GI) and non-GI symptoms in people exposed to gluten, in a randomized placebo-controlled trial presented at DDW.

Celiac disease, which is triggered by the ingestion of gluten, is managed with a gluten-free diet. However, symptoms often recur as a result of accidental exposure to gluten or not strictly following the diet. Recently published data suggest that 70% of patients continue to be exposed to gluten while on a gluten-free diet. This exposure causes not only GI-related symptoms, but also non-GI symptoms such as headache and tiredness. Larazotide acetate reduced both types of symptoms in this trial.

Larazotide acetate has the potential to be the first pharmacologic treatment for celiac disease and warrants investigation in phase 3 clinical trials, the study author concluded. The drug has been granted Fast Track status by the US Food and Drug Administration.

Gastric emptying improved by an average of 23 minutes from baseline, and also reduced vomiting episodes and vomiting severity, when taken by twice-daily injection for 4 weeks.

Ghrelin is a hormone produced in the stomach that stimulates gastrointestinal activity. Relamorelin promotes activity of ghrelin.

Brush Biopsy Ups the Detection of Barrett's Esophagus

May 06, 2014 – A study presented at DDW shows that a procedure using a computer-assisted technique where a brush collects a tissue sample (biopsy) may be better at detecting Barrett’s esophagus than the traditional forceps biopsy method. Barrett’s esophagus, a condition marked by cellular changes, is a risk factor for esophageal cancer.

Investigators reviewed data on patients who underwent endoscopy for the evaluation of gastroesophageal reflux disease from 28 community based gastroenterologists. Both brush biopsy samples and forceps biopsy samples were collected on each patient during the same endoscopy procedure.

Forceps biopsy identified Barrett's esophagus in 377 cases and the computer assisted brush biopsy identified an additional 258 cases, enhancing the detection of Barrett's esophagus by 68.4%. The authors conclude that this technique, used by community gastroenterologists, may help improve care by better identifying these patients.

Low FODMAP Diet May Help Children with IBS

May 06, 2014 – A small, short-term diet low in certain types of poorly absorbed and highly gas-forming carbohydrates (FODMAPs) may reduce symptoms in children diagnosed with irritable bowel syndrome (IBS), according to an abstract presented by researchers at DDW. In the nine-day study, children had fewer daily abdominal pain episodes, as well as less bloating and nausea, during the two-day periods on which they ate low-FODMAPs.

Additional studies are underway to further explore the efficacy of low-FODMAP diets and how they interact with other existing factors.

FODMAPs are found in many fruits, vegetables, dairy products, and sweeteners. Find out more about FODMAPS on our website aboutIBS.org.

May 03, 2014 – A swallowed capsule that vibrates as it moves through the digestive tract has shown promise as a non-pharmacological treatment for constipation, according to preliminary research presented today at DDW.

In a small pilot study, the vibrating capsule was found to nearly double the weekly bowel movements (from 2 to 4) of patients suffering from chronic idiopathic constipation (CIC) and constipation predominant irritable bowel syndrome (C-IBS).

This treatment could offer an alternative for those who treat constipation with medication but who are unsatisfied with the treatment due to side effects, safety concerns, or efficacy. A controlled, double blind study to expand on these findings and further explore the capsule’s potential is being planned.

Use of Lincalotide Reduces Bloating, Improves Health Related Quality Of Life

May 1, 2014 – Research summaries presented at DDW reviewed data from Phase 3 and Phase 3b clinical trials of linaclotide (Linzess) in people with chronic constipation.

New data from a Phase 3b trial showed that linaclotide improved bowel and abdominal symptoms, in those with chronic idiopathic constipation with prominent bloating at the start of the trials.

Data from two Phase 3 trials was pooled to review the relationship between chronic constipation symptoms, and health-related quality of life (HR-QOL). The study concluded that reduction in bloating was more strongly associated with improved HRQOL than other chronic constipation symptoms.

Higher Prevalence of Celiac Disease among Children with IBS

April 21, 2014 – A study published in the journal JAMA Pediatrics found a 4-fold increased incidence of celiac disease among children with irritable bowel syndrome (IBS), but not in children with other functional abdominal pain conditions. This is similar to a recent finding in adults.

Results showed that 4% of the children with IBS tested positive for celiac disease, compared with 1% or less of those with functional dyspepsia and with functional abdominal pain.

The authors state that the identification of IBS as a risk factor for celiac disease might be of help in pediatric primary care, because it has become routine to test for celiac disease in all children with recurrent abdominal pain. Limiting celiac screening only to those with IBS may be beneficial in two ways. First it may reduce unneeded testing and screening costs in children who are no more likely than the general population to have celiac disease. Secondly, it could reduce the risks and long-term health consequences for children with IBS who are also living with untreated celiac disease.

Less Aggressive Treatment May Be Warranted for Many Cases of Diverticulitis

April 10, 2014 – Diverticulitis is a common disease in which small pouches in the GI tract become infected. A recent review of medical studies about diverticulitis that have been published over the past decade suggests that changes be made in the way the disease is often treated.

The reviewers observed advances in the understanding of diverticulitis, which warrant less frequent use of antibiotics and surgery. Among the findings were that the risk of recurrence of diverticulitis is low, and the risk of abdominal infection decreases with each recurrence.

This review was recently published in the Journal of the American Medical Association (JAMA). The authors conclude that future studies are needed to investigate interventions to reduce recurrence, especially given the increasing incidence of diverticulitis.

Survey—Many Want Medication to Treat Celiac Disease

April 9, 2014 – Many people suffering from celiac disease are interested in potential medications to treat the condition, according to a published survey that measured the impact of celiac disease on a person’s life. Currently, a gluten-free diet is the only treatment for celiac disease.

Survey responses were analyzed from 352 patients with biopsy-confirmed celiac disease. Patients were asked whether they would take a medication to treat the condition, if available. Interest was highest among men, older respondents, frequent restaurant customers, those dissatisfied with their weight or concerned with the cost of a gluten-free diet, and those with a worse quality of life. Length of time since diagnosis and response to a gluten-free diet did not appear to increase interest in using medication.

A New Way to Contact the FDA’s Food and Cosmetics Information Center

April 8, 2014 – The FDA’s Center for Food Safety and Applied Nutrition (CFSAN) Food and Cosmetics Information Center (FCIC) has a new online contact form, enabling industry representatives and consumers to submit their inquiries electronically through the FCIC website.

The new online form will collect information needed to appropriately and efficiently prioritize and respond to each inquiry, allowing the FCIC to improve overall customer service and increase accurate and timely responses. The form is available at this link.

The Center for Food Safety and Applied Nutrition, known as CFSAN, is one of six product-oriented centers that carry out the mission of the Food and Drug Administration (FDA). CFSAN, in conjunction with the Agency's field staff, is responsible for promoting and protecting the public's health by ensuring that the nation's food supply is safe, sanitary, wholesome, and honestly labeled, and that cosmetic products are safe and properly labeled.

MRI modeling revealed abnormal anatomical structure in those with GERD

April 3, 2014 – A small study has demonstrated that magnetic resonance imaging (MRI) technology can reveal anatomical and functional differences between people with gastroesophageal reflux disease (GERD) and those without. The differences affect the normal way in which the esophageal and gastric (stomach) anatomy acts to prevent reflux.

The findings demonstrate in a non-invasive testing situation that the “functional anatomy” which normally helps provide a barrier to reflux, is altered in people with mild to moderate GERD. This helps to better understand the mechanisms by which reflux is normally prevented, as well as the changes which allow it to occur.

Salmonella Gastroenteritis During Childhood is a Risk Factor for Irritable Bowel Syndrome in Adulthood

March 24, 2014 – Based on data collected from a single foodborne Salmonella outbreak in 1994, researchers have shown that Salmonella-induced gastroenteritis during childhood (but not adulthood) is a risk factor for irritable bowel syndrome (IBS).

The researchers identified and monitored a foodborne Salmonella outbreak that involved 1,811 people (mostly children) in Bologna, Italy. Clinical data were collected and long-term effects were assessed by mailing a questionnaire to 757 subjects, 16 years after the outbreak (when all of children were adults).

The prevalence of IBS was higher in individuals exposed to Salmonella as children, but not as adults, compared with controls. The authors conclude that given the high prevalence of acute gastroenteritis and Salmonella infection early in life, preventive measures may help reduce the risk of IBS in adulthood.

Researchers Find Genetic Clue in Irritable Bowel Syndrome

March 20, 2014 – A group of researchers studying a specific genetic defect concluded that about 2% of people with irritable bowel syndrome (IBS) carry a mutation in the SCN5A gene.

Probiotics May Reduce Diarrhea Burden in Preschoolers

March 17, 2014 – A randomized, double-blind, placebo-controlled trial found that children who received a prescribed daily doses of a specific probiotic had less days with acute infectious diarrhea as well as fewer episodes of diarrhea. The study was performed at four day care centers in Mexico in children under three years old.

Daily use of the live probiotic Lactobacillus reuteri DSM 17938 was also associated with a reduction in the number of days the children were absent from school and the number of times they visited the doctor. Results from the study can be used to establish evidence-based recommendations for the use of this probiotic in the prevention of infectious diseases in day care centers.

Small Particle Size Diet Helps Those With Diabetic Gastroparesis

March 14, 2014 – A randomized controlled trial examined the effect of an experimental diet in people with diabetic gastroparesis, and found that a small-particle size diet may relieve upper gastrointestinal (GI) symptoms.

Dietary restriction is required to treat both gastroparesis and diabetes. This study tested a usual diet for diabetes versus a nutritionally identical experimental diet, which differed regarding the particle size of the food. This was described as food that was "easy to mash with a fork into small particle size, e.g. mealy potatoes". Foods with husks or peels; seeds and grains; or compact, poorly digestible particles such as meat, raw vegetables, and pasta; were excluded.

GI symptoms such as nausea/vomiting, fullness after meals, and bloating were all reduced in those who received the small-particle diet. Nutrient intake, glycemic control, and quality of life were the same in both diets, although longer studies may be needed to test these findings.

Although dietary changes are frequently recommended for controlling GI symptoms in people with diabetic gastroparesis, this is the first randomized controlled study of a diet for diabetic gastroparesis. The 20-week study included 56 adults with insulin treated diabetes and gastroparesis.

The Role of the Gut Microbiota in IBS and Bloating

March 10, 2014 – "Recent findings suggest that IBS is linked to clearly detectable gut microbiota alterations. Additionally, bloating can be related to specific kinds of diet, thus opening up promising paths towards an efficient disease management," says Professor Giovanni Barbara (University of Bologna, Italy). This was one of the topics presented at the Gut Microbiota for Health World Summit in Miami, FL, USA on March 8 and 9, 2014.

"Probably the best example of this interaction is the discovery that IBS symptoms develop in up to 10 percent of previously healthy subjects after a single episode of gastroenteritis caused by an infection through bacterial pathogens like salmonella, shighella or campylobacter, which can severely disrupt the microbiota balance," says Prof. Barbara.

Another important factor is nutrition. Recent studies show that certain foods can induce profound changes in the microbiota of IBS patients, thus prolonging and increasing the symptoms. The gut microbiota of healthy subjects remained stable and unaffected by these foods.

Read the full article from the American Gastroenterological Association here.

Fifty Years Later: Post-infectious Irritable Bowel Syndrome

February 28, 2014 – Post-infectious irritable bowel syndrome (PI-IBS) is a type of IBS which occurs after what appears to be a bout of infection in the stomach and intestines (gastroenteritis). While most people recover completely after the initial illness, some people do not. The infectious agent in PI-IBS is usually bacterial.

It has been 50 years since researchers first published a paper associating acute infectious gastroenteritis with persistent GI symptoms. An article published in the journal Neurogastroenterology & Motility reviewed the literature to determine what we have learned about PI-IBS in the past 50 years.

Many risk factors and mechanisms for PI-IBS have been discovered, including what type of infections are most likely to be associated with later symptoms. This research is helping to guide new treatments and understanding of IBS.

New Drug Application Submitted in Japan for the Treatment of Acid-related Diseases

February 28, 2014 – Takeda Pharmaceuticals has announced that they have submitted a new drug application (NDA) in Japan for a new class of drug to treat acid-related disorders.

The compound has been assigned the generic name vonoprazan fumarate. It belongs to a new class of acid secretion inhibitors called potassium-competitive acid blockers. They work slightly differently from proton-pump inhibitors (PPIs), which are currently among the most common treatments for these disorders.

The NDA was submitted based on positive results from Phase III clinical trials in Japan, for indications including erosive esophagitis, gastric ulcer, duodenal ulcer, and H. pylori eradication.

Small Intestinal Bacterial Overgrowth in Gastroparesis

February 28, 2014 – A study has shown that small intestinal bacterial overgrowth (SIBO) can be somewhat common in those with gastroparesis.

In a study of 740 patients who were tested for SIBO, 39% of those who had gastroparesis tested positive. Overall, no significant difference in gastroparesis symptom severity was seen between positive and negative results in those with gastroparesis, but there was increased severity of bloating and excessive fullness during and after meals. Read the article abstract.

Capsule Bowel Prep in Development

February 27, 2014 – Salix Pharmaceuticals is partnering with another company to develop a bowel prep compound that is in the form of a tasteless capsule.

Currently, people preparing for abdominal procedures or diagnostic tests such as colonoscopy must drink a bowel prep solution to help cleanse the gastrointestinal tract. Most liquid preparations require drinking a large quantity of the prep which many people find unpleasant to the taste. The RHB-106 preparation is a solid capsule which eliminates any unpleasant taste and could potentially make it easier for people to use.

Early Research Suggests that IBS may Sometimes be Associated with Maternal Inheritance

February 26, 2014 – A small pilot study may show that some irritable bowel syndrome (IBS) is hereditary, and linked to DNA in the cells of the mother.

By analyzing the mitochondrial DNA of patients with IBS, inflammatory bowel disease (IBD), and healthy controls, scientists found probable maternal inheritance in 17.5% of the people with IBS, compared to only 2% of otherwise healthy people and 0% the people with IBD.

Mitochondria are important structures inside our cells, and in humans are inherited only from the mother. Mitochondrial dysfunction has been implicated in disorders that often co-occur with irritable bowel syndrome, such as migraine, depression, and chronic fatigue syndrome. These findings suggest that about 1 person in 6 with IBS could have an IBS subtype related to mitochondrial function, and that further research in this area is warranted. Read the article abstract.

Researchers Discover Mechanism of Movement in the Bowels

February 26, 2014 – Researchers led by a group at McMaster University in Canada have discovered a mechanism that helps us better understand how the bowels function. The finding may lead to a better understanding of how to treat people with disorders of nutrient absorption, diarrhea, constipation, and bloating.

Food in the intestine must be propelled along the gut from the stomach down to the colon (a movement referred to as peristalsis), and it also must be mixed to maximize the absorption of nutrients.

The mechanism of peristalsis has previously been demonstrated to be the result of a slow-wave pacemaker generated by special cells in the intestinal walls, called interstitial cells of Cajal (ICCs).

The researchers discovered that the mixing movement is generated by a second pacemaker that interacts with the first. Together, they create back and forth movements that optimize nutrient absorption. Read the article abstract.

IBS Patients’ Self-Health Ratings Look Beyond GI Symptom Severity

February 14, 2014 – People with irritable bowel syndrome (IBS) tend to base self-ratings of health by including other factors in addition to their IBS symptoms, a recent study suggests.

The study looked at a sample of people with moderate to severe IBS, in order to understand how they rate their own health. The resulting self-ratings were correlated more with physical, psychological, and social issues rather than just with their IBS symptom severity. Worse perceptions of health included more severe non-digestive symptoms (such as fatigue), greater psychological distress, and more stressful life circumstances.

This finding suggests that improving treatments for IBS requires addressing more than just IBS symptom severity in order to increase an individual’s overall perception of health. Read the article abstract.

Probiotic Treatment for IBS Available Over the Counter in Ireland

February 14, 2014 – An over the counter probiotic treatment for irritable bowel syndrome (IBS) is now available in Ireland.

The active probiotic culture, bifidobacterium infantis 35624, was originally discovered at the University College Cork, Ireland in the late 1990s. Since then, it has undergone clinical trials which have validated its efficacy in treating IBS symptoms.

This probiotic has already been approved for over the counter use in the US and Canada under the brand name Align, and will be sold under the brand name Alflorex in Ireland.

Hospitalizations for Constipation Increasing in Cost and Frequency

February 11, 2014 – New data shows that hospitalizations for constipation are increasing in frequency, and the associated costs are rising.

Researchers analyzed the National Inpatient Sample Database for hospital discharge codes related to constipation, from 1997-2010. This database contains records for over 7 million hospital visits per year.

From 1997 to 2010, discharges with a principal diagnosis of constipation increased by 128.6%. The average hospital charges for these patients increased 239.3% ($8,869 in 1997, adjusted for inflation, to $17,518 in 2010), although the average length of hospital stay only increased from 3.0 to 3.1 days in the same time.

The researchers speculate that the increase in hospitalizations for constipation may be due to the increasing use of medications that cause constipation, and that the cost increase is likely due to the increased number of diagnostic tests performed to test colon function. They conclude that constipation is an escalating burden on the health care system and recommend studies on preventative measures that could reduce this. Read the article abstract.

Positive Phase 3 Trial Results of Eluxadoline in Patients with IBS-D

February 4, 2014 – Two Phase III clinical trials evaluating eluxadoline in the treatment of diarrhea-predominant irritable bowel syndrome (IBS-D) has shown that the medication helps improve both stool consistency and abdominal pain. A total of 2,428 subjects were enrolled across the two randomized, double-blind, placebo-controlled studies.

The manufacturer, Furiex Pharmaceuticals, is hoping to file a New Drug Application with the FDA sometime in mid 2014. Eluxadoline has been granted Fast Track status by the FDA, a process designed to facilitate development and expedite the review of drugs to treat diseases with significant unmet medical need.

January 22, 2014 – A Phase 2b study of a new method for treating nausea and vomiting in diabetic gastroparesis seems to show benefit over a traditional form of the treatment.

The study looked at the efficacy and safety of metoclopramide as taken by a new nasal-spray delivery method versus by the usual oral tablets.

Delayed gastric emptying symptoms, which are typical of gastroparesis, can interfere with the absorption and efficacy of oral medications. A nasal spray is absorbed through the nasal membrane bypassing the gastric emptying. A Phase 3 study to further investigate the potential of this form of treatment is upcoming.

New Treatment for IBS with Diarrhea Available for Men in Japan

January 17, 2014 – Ramosetron hydrochloride (HCl) tablets have been approved in Japan for treating diarrhea-predominant irritable bowel syndrome (IBS-D) in males. The drug will be available under the brand name Irribow OD.

Ramosetron HCl is a serotonin 5-HT3 receptor antagonist. It acts on 5-HT3 receptors in the gut to slow intestinal transit and can also reduce transmission of intestinal pain. It is currently only approved for use in select countries including Japan and India, but is under investigation in several other countries.

New Type of Fiber to be Tested in Treating IBS Symptoms

January 16, 2014 – Scientists from two universities are collaborating to develop and test a new type of fiber which may be useful in treating irritable bowel syndrome (IBS).

The fiber was designed to reduce bloating, a common side effect of current fiber therapies for IBS. It was also designed to break down into a product which helps promote healthy intestinal flora, and to deliver these nutrients farther into the large intestine. Most fibers are broken down in the stomach and small intestine.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) has awarded these researchers a grant to conduct a two-year clinical trial which will test the new fiber. The trial will be starting in early 2014.

FDA Offers New Online Reporting Method for Dietary Supplements

January 13, 2014 – The U.S. Food and Drug Administration (FDA) is now accepting online submission of adverse event reports related to the use of dietary supplements. Both mandatory and voluntary adverse event reports may be submitted online. Reporting of dietary supplement adverse events is important in protecting consumers’ health and safety. The FDA routinely monitors the marketplace. However, with more than 85,000 dietary supplements on the market and no product specific registration requirement, adverse event reporting is invaluable in identifying harmful products.

NPR: Doctors Say Request for IBS Research Money is No Joke

January 16, 2014 – Recently NPR and other news channels reported that in his new memoir, former Secretary of Defense Robert Gates ridiculed investments in irritable bowel syndrome (IBS) research.

Now NPR has heard from doctors who treat Gulf War veterans, and researchers with the National Academy of Sciences' Institute of Medicine, including IFFGD board member Dr. Douglas Drossman, who say this is not so. IBS is a serious concern for returning military women and men. Read the full article here.

Social Security Announces New Compassionate Allowances Conditions

January 15, 2014 – The Social Security Administration (SSA) announced that they have added 25 new Compassionate Allowances conditions, including chronic intestinal pseudo-obstruction (CIP).

CIP is a rare disorder of gastrointestinal motility where coordinated contractions (peristalsis) in the intestinal tract become altered and inefficient. When this happens, nutritional requirements cannot be adequately met. Pseudo-obstruction in children is usually congenital, or present at birth. It may also be acquired, such as after an illness. Read more about the symptoms and treatment of CIP here.

The Compassionate Allowances program expedites disability decisions for Americans with the most serious disabilities to ensure that they receive their benefit decisions within days instead of months or years. Read the full press release here.

Ondansetron May Ease Some IBS-D Symptoms

January 10, 2014 – A new study from Garsed and colleagues in the UK suggests that the prescription drug ondansetron (Zofran, Zuplenz) may relieve some of the symptoms of diarrhea-predominant IBS (IBS-D). Ondansetron has been in use for many years to decrease nausea and vomiting related to chemotherapy.

In the study, ondansetron was most useful to improve frequent loose stools and urgency in people with mild to moderate symptoms. No significant improvement was seen in abdominal pain. Reportedly, any benefit is usually seen within a few days.

January 9, 2014 – Many women suffer from pelvic floor dysfunction (PFD), which can cause a range of symptoms that include bladder and bowel problems, such as constipation or incontinence, as well as pelvic pain.

A retrospective study from the University of Missouri concluded comprehensive pelvic floor rehabilitation, which may include exercises to strengthen or relax the pelvic muscles, biofeedback therapy, constipation management, medications, incontinence devices, and behavioral modification, can help provide relief without surgery.

Existing records from nearly 800 women who had undergone therapy were examined. Those who completed at least 5 comprehensive rehabilitation sessions reported an average of 80% improvement in urinary incontinence, bowel dysfunction, and pelvic pain. Women who have symptoms of pelvic floor dysfunction are encouraged to discuss their concerns and treatment options with their health care providers.

New Use for Imaging Technique in the Treatment of IBS

January 8, 2014 – Researchers at the University of Nottingham, including IFFGD Advisory Board member Robin Spiller, MD, are researching how Magnetic Resonance Imaging (MRI) can be used to study irritable bowel syndrome (IBS).

In three new studies, Dr. Spiller and colleagues have used MRIs to study the volume of the colon and how it expands to make space for a meal; the transit time of a meal through the bowel; and how certain food triggers such as fructans and glucose act differently in different parts of the colon.

Their findings will help show how the bowel functions differently between healthy individuals and those with IBS. "In future," says Dr. Spiller, "We will be able to use our MRI techniques to test specific foods to understand how they will affect IBS."

FDA Issues Warning to Consumers on Certain OTC Laxatives

January 8, 2014 – The Food and Drug Administration (FDA) has issued a warning to consumers that some of the over-the-counter (OTC) laxatives – those called sodium phosphate laxatives – are potentially dangerous if dosing instructions or warnings on the Drug Facts label are not properly followed or when there are certain coexisting health conditions.

The label of sodium phosphate laxatives states that they should be used as one dose per day for no more than three days. If you do not have a bowel movement after taking a dose, you should not take another dose of the product.

FDA is now warning that adults older than 55, and adults and children with certain health conditions or who are using certain other medications – including ibuprofen – should ask their doctor before using these products because they may be at increased risk for harmful side effects. These new warnings are not currently in the Drug Facts label and apply to both adults and children. Read the full FDA update here.